Bill To:


DAIRYLAND COUNTY MUTUAL INSURANCE
1800 North Point Dr,
Steven's Point, WI 54481-1253

Services Rendered To:


Shaquille Milton
702 Mimosa Ln
Atlanta, TX 75551
POLICY# 26441

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BY-205-23-929 09/29/2023 10/10/2023 On Receipt Douglassville V.F.D.

Product
Price
Qty
Amount
  1. 102 Engine Response (Per Hour)

    $500.00
    1.5
    $750.00
  2. 302 Hand Light (# Used)

    $5.00
    2
    $10.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: SH 77 West of FM 994- Douglasville, TX

    Ordinance Info: Douglassville Volunteer Fire Dept. Resolution

Subtotal $910.00
Total Due $910.00


Updated
October 10, 2023 @ 2:10 pm

Invoice updated by Geoffrey.

Status Update
October 10, 2023 @ 2:10 pm

Status changed: Draft to Pending.